Cynthia Todd has been suffering from chronic pain caused by Reflex Sympathetic Dystrophy (RSD) for over a decade. The constant burning and aching sensation that is common with RSD left her severely depressed. “I wanted to die. I literally wanted to die,” Todd recalls.
In desperation, she turned to Dr. Todd Hutton, a psychiatrist in Beverly Hills, California. Hutton uses a relatively new procedure, transcranial magnetic stimulation (TMS), to treat patients with major depression who have not had success with anti-depressant medication.
“I’ve gone through many types of treatment and I’ve never looked forward to anything more than this,” says Todd, who began TMS therapy about a year ago. “It’s the only thing that worked.”
At the Southern California TMS Center, the painless 40-minute procedure is conducted on an outpatient basis. The facility, like a surgical center, is used by nine different psychiatrists exclusively for TMS therapy. Patients receive TMS treatments five days a week for four to six weeks, followed by sporadic single maintenance treatments –which may go on indefinitely.
TMS generates highly concentrated magnetic fields which turn on and off rapidly. These magnetic fields — the same type as those produced by a magnetic resonance imaging machine (MRI) – target a part of the brain involved with mood regulation, which is underactive in depressed patients. The magnetic fields produce small electric currents that activate cells within the brain, which are thought to release neurotransmitters (serotonin, norepinephrine and dopamine), chemical messengers that improve mood and make depressed people feel better.
“In depression, we’ve learned that there are areas of the brain that are underactive, particularly in the left frontal lobe,” Hutton explains. “And people had the idea that if we could stimulate this area of the left frontal lobe perhaps we could reverse the effects of depression. And that turned out to really work.”
TMS therapy is being used to treat addiction, fibromyalgia and migraines — with encouraging results. The U.S. Army and the National Institutes of Health have also been experimenting with TMS to ease Phantom Limb Pain, which is experienced by many amputees.
TMS has been used to treat depression in the U.S. since it received approval from the Food and Drug Administration in 2008. As yet, there are no known long-term adverse side effects. Cost of treatment depends on the number of applications and whether TMS is covered by insurance. While TMS is FDA approved, some insurers still label it investigational and experimental, even though it’s part of the American Psychiatric Association’s treatment guidelines for depression.
Hutton believes TMS is cost effective for both insurers and patients because it reduces the need for medication and other procedures used to treat depression.